Individual
TIM ALLEN SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2501 KEENAN DR, INTERNATIONAL FALLS, MN 56649-2181
(218) 283-9431
Mailing address
2501 KEENAN DR, INTERNATIONAL FALLS, MN 56649-2181
(218) 283-9431
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
53656
MN
208D00000X
General Practice Physician
53656
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1881821619
—
MN
05
—
1881821619
—
WI
Enumeration date
06/19/2009
Last updated
12/05/2016
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